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Intracoronary Versus Intravenous Administration of GP IIb/IIIa Inhibitor Improves Myocardial Reperfusion in STEMI Patients

Author: ZhangYouSheng
Tutor: ZhouXuChen
School: Dalian Medical University
Course: Internal Medicine
Keywords: Thrombus Aspiration Tirofiban With acute ST- segment elevation myocardial infarction
CLC: R542.22
Type: Master's thesis
Year: 2011
Downloads: 1
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Abstract


Objective: To explore the safety and effectiveness of comparison of intracoronary versus intravenous administration of the glycoprotein IIb/IIIa inhibitor improves myocardial microcirculation during primary percutaneous coronary intervention (PPCI)for acute ST-segment elevation myocardial infarction (STEMI).Methods: From 1st, 2009 to 12th 2010 total 177 consecutive patients according with ACC/AHH guidelines defined STEMI, confirmed thrombi lesions by coronary angiography and thrombus score remained >2 score after the aspiration by DIVER C.E catheter thrombus aspiration. The patients were randomized to intracoronary administration of Tirofiban (groupA, 92patients) and conventional intravenous administration Tirofiban(groupB, 85patients).GroupA: intra-infarct related artery (IRA) administration of 10μg/kg of Tirofiban 3min via DIVER C.E catheter, subsequently intravenous infusion of 0.1μg·kg-1·min-1 of Tirofiban for 6-8 hours after PPCI. Group B: intravenous administration of 10μg/kg of Tirofiban 3 minutes, subsequent intravenous infusion of 0.1μg·kg -1·min-1 of Tirofiban for 24-36 hour after PPCI. All of the patients received Aspirin 100mg/d, Clopidogrel75mg/d, and subcutaneously low molecular heparin (60 U/kg body weight) after PPCI. Factors as clinical general status, corrected TIMI frame count(CTFC), myocardial blush grade (MBG), ST-segment elevation resolution (STR, >70%) at 24-hour after PPCI, the peak of creatine troponin I (CTn-I), the Ratio of no-reflow/slow- flow, complications as haemorrhage, thrombocytopenia, and in-hospital/30 days major adverse cardiac event (MACE, cardiac death, repeat myocardial infarction and acute heart failure ) were evaluated.Results: There was no difference in baseline characteristics between two groups. Compared with group B, group A showed lower ratio no-reflow/slow-flow phenomenon (4.3% vs.14.1%, P=0.006). TIMI frame count (24.1±16.67 vs.26.67±18.34, P=0.004), MBG (2.03±0.32 vs.1.12±0.47, P=0.021), ST fall-after-rise >70% within 24 hours (67% vs.57%, P=0.003), and the peak of CTn-I (2.77±0.43 vs. 3.98±0.63, P=0.016) indicated that intracoronary Tirofiban may be helpful for myocardial reperfusion. The MACE of in-hospital/30 days follow-up (6.5% vs. 18.8%, P=0.001) were also lower in group A, especially in cardiac death (2.2% vs. 7.1%, P=0.001), repeat myocardial infarction (1.1% vs.3.5%, P=0.008) and acute heart failure (3.3% vs.8.2%, P=0.002). Major bleeding (1.1% vs.4.7%, P =0.003) was lower in group A and the thrombocytopenia was similar in both groups (2.2% vs. 3.5%, P=0.13).Conclusions: During PPCI for STEMI patients with big thrombus burden after aspiration methods, compared with intravenous administration, Intracoronary administration of Tirofiban may improve myocardial reperfusion, decreasing no-reflow phenomenon, reducing hemorrhages events.

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CLC: > Medicine, health > Internal Medicine > Heart, blood vessels ( circulatory ) disease > Heart disease > Myocardial diseases > Myocardial infarction
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